Letícia Martins Azeredo

Ultrasound in schistosomiasis mansoni

We reviewed ultrasound features in patients with schistosomiasis mansoni. The alterations that we observed in acute and hepatosplenic schistosomiasis are described. The advantages and disadvantages of using ultrasound patterns in the evaluation of liver fibrosis are discussed. Other diseases that are important in the differential diagnosis of schistosomal liver fibrosis are presented. Ultrasound is an effective and flexible diagnostic tool in the evaluation of a variety of diseases. It presents no harmful effects to patients, allowing non-invasive studies in hospitalized patients and in other facilities.

Estudo Doppler na hipertensão portal

Ultrasonography and Doppler ultrasonography have dramatically improved the diagnosis of portal hypertension thanks to the noninvasive visualization of the liver, spleen and splanchnic blood flow. In this article the authors discuss some important issues raised by the use of ultrasound and Doppler in the evaluation of portal hypertension.

Aspectos ultrassonográficos e hemodinâmicos da esquistossomose mansônica : avaliação pela ultrassonografia Doppler em áreas endêmicas.

OBJECTIVE: The present field research was aimed at identifying sonographic and hemodynamic findings indicative of the presence of schistosomiasis mansoni in endemic areas. MATERIALS AND METHODS: Doppler sonography was performed in 554 patients with schistosomiasis in three areas with different endemicity levels: low (n = 109), medium (n = 255) and high endemicity (n = 190). The World Health Organization (Niamey Working Group, 2000) protocol was adopted for sonographic evaluation. Doppler study included portal vessels, hepatic and splenic arteries, hepatic veins and collateral vessels. RESULTS: A significant correlation was observed between the frequency of sonographic findings, except for left lobe hypertrophy, and the areas endemicity levels. Altered hepatic veins flow pattern was observed in 23.7% of cases, such abnormality being related to the presence and intensity of periportal thickening. Hepatic arteries did not present any alteration as related to the evaluated parameters. Collateral vessels were identified only in the patients from the high-endemicity area. The splenic artery presented alterations (increase in caliber, flow velocity and resistive index), most frequently in the high-endemicity area, with significant difference between groups. CONCLUSION: Doppler sonography has shown to be a relevant auxiliary tool in the study of the morbidity related to schistosomiasis mansoni, contributing for a more accurate description of the disease profile in endemic areas.

Abdominal ultrasound in the evaluation of fibrosis and portal hypertension in an area of schistosomiasis low endemicity

This study was undertaken in the municipality of Bananal, São Paulo, an endemic area for schistosomiasis with a prevalence under 10% and low parasite load among infected individuals. Our objective was to identify the clinical forms of schistosomiasis among 109 patients in whom the disease had been diagnosed through direct fecal analysis and who had been medicated with oxamniquine at the time of the Plan for the Intensification of Schistosomiasis Control Actions (1998-2000). These patients were submitted to an abdominal ultrasonography and fecal analysis by Kato-Katz method, four years, on average, after the end of the Plan. Five patients, whose abdominal ultrasound images were compatible with either peripheral or central periportal fibrosis and portal hypertension, were identified. None of the 109 patients presented Schistosoma mansoni eggs at fecal analysis. Ultrasonography is a sensitive, noninvasive diagnostic method that allows a better identification of the extent of liver involvement in schistosomiasis cases.

Aspectos ultra-sonográficos da trombose da veia porta

Portal vein thrombosis may be associated with many alterations, such as the presence of tumors (for example, hepatocellular carcinoma, metastatic liver disease and carcinoma of the pancreas) as well as pancreatitis, hepatitis, septicemia, trauma, splenectomy, portacaval shunts, hypercoagulable conditions (for example, pregnancy), in neonates (for example, omphalitis and umbilical vein catheterization) and in acute dehydration. The authors discuss herein the sonographic features of portal vein thrombosis as well as some aspects of clinical relevance.

Múltiplos pequenos nódulos hepáticos hiperecogênicos sem reverberação sonora posterior: outra forma de apresentação dos hamartomas dos ductos biliares

O aspecto ultra-sonografico dos hamartomas dos ductos biliares pode variar, sendo importante reconhecer suas diferentes formas de apresentacao, para que possam ser lembrados no diagnostico diferencial de lesoes focais hepaticas. Neste trabalho, os autores apresentam um caso desta afeccao em que foram identificados inumeros nodulos hiperecogenicos dispersos pelo parenquima hepatico, com os maiores atingindo 1,6 cm, sem produzir reverberacao sonora posterior.

Análise evolutiva e perspectiva histórica da ultra-sonografia intra-operatória (USIO) nas afecções pancreáticas

Intraoperative ultrasonography influences surgical strategy in a significant number of patients operated due to benign or malignant conditions, and is the most sensitive technique for the detection of small lesions, particularly in the liver and in the pancreas. In pancreatic surgery, intraoperative ultrasonography is helpful in the localization of islet cell tumors and in the assessment of the resectability of adenocarcinomas. The technique may also play a role in chronic pancreatitis surgery. The authors present an up-to-date review of the evolution of intraoperative ultrasonography in pancreatic surgery.

PANCREATITE AGUDA LEVE: AVALIAÇÃO PELA ULTRA-SONOGRAFIA. ESTUDO PROSPECTIVO*

We analyzed the ultrasonographic findings of 21 patients with mild acute pancreatitis. The presence or absence of pancreatic hypoechogenicity and peripancreatic fluid collection was assessed. Pancreatic hypoechogenicity was identified in 19 patients (90.5%) whereas small sac fluid collection was identified in 3 (15.8%) of these patients. No abnormality was seen in 2 patients (9.5%). Regarding the etiology of acute pancreatitis, cholelithiasis was identified in 15 patients (71.5%), alcohol abuse was identified in 4 patients (19.0%), and in 2 patients (9.5%) no probable etiology could be found. The authors conclude that ultrasonography may identify abnormalities in the majority of patients with mild acute pancreatitis and can be used to assess patients with peripancreatic fluid collections.

Avaliação ultra-sonográfica e ao Doppler dos TIPS (anastomose portossistêmica intra-hepática transjugular)

Transjugular intrahepatic portosystemic shunts (TIPS) are the most recent and popular technique for the relief of symptomatic portal hypertension, particularly in patients with varices and gastrointestinal bleeding and less often in patients with refractory ascites. TIPS may be complicated by stenosis or occlusion of the stent. Sonography with Doppler provides a noninvasive method for monitoring patients with TIPS. The authors report the recent sonographic and Doppler findings in patients with normal functioning TIPS and patients with stenosis or occlusion of TIPS.

Aspectos ultra-sonográficos da neoplasia epitelial papilífera sólido-cística do pâncreas

The authors report the clinical, gross pathology and ultrasonography findings of 11 prospectively studied patients with solid and papillary epithelial neoplasm of the pancreas (SPEN). The patients were one male and ten females aged 15 to 75 years (mean age at diagnosis: 27 years). All patients had pathology proven SPEN and were submitted to preoperative ultrasonography. The size, location and ultrasonographic features of the tumors were evaluated and correlated with the gross pathology findings. The mean transverse diameter of these tumors was 8.7 cm (range: 4.2 cm to 16.0 cm). Tumors were located in the head (three cases), body (three cases) and tail (five cases) of the pancreas. All lesions were well encapsulated and presented some degree of internal hemorrhage. There was full correlation between ultrasonography and gross pathology findings. In three cases (27.3%) the tumors were predominantly solid, cystic in one case (9.1%), and had equal degrees of solid and cystic components in seven cases (63.6%). Calcifications, predominantly peripheral, were seen in four (36.4%) of the 11 patients. All tumors were in contact with the portal, mesenteric and splenic venous axis. In all cases except one there was no venous invasion. Lymph nodes or distant metastases were not observed in any of the patients. The authors concluded that in all cases there was a correlation between the ultrasonography and gross pathology findings, and although ultrasonography findings are not specific they may be highly suggestive of SPEN in the appropriate clinical context.